Lower Blepharoplasty Revision

A month after Blepharoplasty, my left lower lid looks worse compared to how it looked like before surgery. Now only is it puffy, it now seems to also have an indentation under the puffy area. I am wondering why this happened. I am very discouraged and disappointed with the results as my doctor said that it would not change--and it hasn't. He said there's nothing I could do. I feel I will need revisional surgery of the lower lid, and I'm wondering how long after this first procedure should I wait before I can undergo revision surgery? The doctor who performed the surgery is an oculoplastic surgeon, and I'm wondering if O should find a regular plastic surgeon who is more concerned with aesthetics for this revision.

Doctor Answers 9

It's early but you need close follow up

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Although the eyes tend to heal quite quickly following blepharoplasty prolonged swelling can happen. This more commonly happens with complex lower lid surgery such as when a lid tightening is combined with fat and skin removal and muscle tightening. I like to see my patients often following surgery especially if there are any concerns. Prolonged swelling like this can be helped by a short course of steroids. See you doctor but if you don't get the answeres you need seek a second opinion. This will get better.

Lower eyelid problems

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Lower eyelid surgery can be quite complex. You did not mention your age or the degree of aging you had on the lower eyelids themselves. You mentioned the swelling of the lower eyelid and an indentation. Without a pre and post operative photograph it is difficult to tell what the exact problem is. I would tell you that one month following surgery can be very early in the complete healing process. My advice at this time is gentle massage of the lower eyelid stroking from medial (by the nose) to the outside. I have my patients do this 10 strokes, 10 times per day. Let your surgeon know your exact concern, if you are not satisfied with the answer ask him, in a very non- judgmental fashion, if a second opinion would be appropriate.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Just In case

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Because skin around the eye area is delicate and thin, a blepharoplasty is considered a complex procedure and requires significant skill. If a significant amount of fat was removed, the swelling may persist for a longer period of time. However, it is difficult to determine the precise cause of the prolonged swelling without a physical examination. The eye area needs at least six months to heal after the procedure, and swelling care rarely persist for this length of time around the lower eyelid, so a revision should not be considered prior that milestone.

Give it some more time before considering blepharoplasty revision

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You are still just 4 weeks post-op. My advice at this point would be to wait at least 6 months before considering any kind of revision. It takes several weeks to months for all of the swelling to resolve and the tissues to settle.

If you jump into revisions earlier, then you may actually make everything worse. Also, you may be surprised how tissues even out over this amount of time. If, at that time, your surgeon says there is nothing that can be done, then you may want to check around or get recommendations another local surgeon for additional advice.

Good luck with your recovery.

There may be conservative things you can do right now

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To Post Op Blues,

I would wait at least 6 months before doing revisional surgery, but , depending on your exact problem, simple things like massage, eyelid muscle exercises, taping, or even injections may help right now. An oculoplastic surgeon should be a great person to deal with this problem. So the first thing I would suggest is talk to your surgeon.

Lower eyelid surgery is one of the trickiest things we do, and we do see complications. But they can almost always be corrected.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Puffiness and revision after eyelid surgery

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Puffiness and revision after eyelid surgery
Revision Surgery
Revision eyelid surgery should be done at least 6 months after the initial surgery to allow time for healing and tissues to soften. Asymmetries, excess skin, fat rolls, fat malposition can all be improved. Other treatments may include laser or chemical peels to tighten skin and improve texture

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Wait 3-4 months after initial blepharoplasty

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One should wait at least three to four months after a blepharoplasty procedure to undergo a revision lower blepharoplasty procedure. Most oculoplastic surgeons understand the anatomy of the lower lids quite well. A facial plastic surgeon who has extensive experience in eyelids can also assist you with a revision.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Nothing you can do... for now.

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Dear Blues,

Suzyque is right on. Thanks Suzy. One month out from any surgery is too early to critically evaluate your results. There will be swelling and scarring changes that will take place for several months at least. Hopefully what your surgeon said was "nothing to do right now". Be patient. Your results should continue to improve over the next 2-3 months. If not, see your local board certified plastic surgeon for another opinion. Good luck!

Swelling or unreasonable expectations

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Of course, swelling plays a role in any surgery, but sometimes it is the expectations after surgery that have to be adjusted. The anatomical variants of the lower eyelid make it difficult to make every eyelid look smooth and perfect.

Without an exam, I certainly cannot judge. However, keep this in mind when you seek out your second opinion.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.